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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197410539
Report Date: 09/05/2024
Date Signed: 09/05/2024 02:49:45 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2024 and conducted by Evaluator Judy Laureano
COMPLAINT CONTROL NUMBER: 30-CC-20240821131500
FACILITY NAME:SANTA MONICA MONTESSORI SCHOOLFACILITY NUMBER:
197410539
ADMINISTRATOR:CRISMAN, PAMELA J.FACILITY TYPE:
850
ADDRESS:1909 COLORADO AVENUETELEPHONE:
(310) 829-3551
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY:97CENSUS: 43DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Pamela CrismanTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Record Keeping: Staff records are outdated/incomplete.

Record Keeping: Staff is providing care and supervision to daycare children without the proper required training.

Reord Keeping: Children's files are incomplete.
INVESTIGATION FINDINGS:
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On 9/5/2024 Licensing Program Analysts (LPA) Judy Laureano arrived at the above mentioned facility for the purpose of delivering findings on the above mentioned allegations. Upon arrival, LPA met with Director Pamela Crisman and discussed the purpose of the visit. LPA toured the facility both indoors and outdoors and observed 43 children and 6 staff members providing care and supervision.

LPA Laureano reviewed 10 staff files and found files incomplete. LPA observed 5 out of 10 files missing proof of immunization records, MMR and tdap. LPA also found 2 out of 10 files missing the LIC 503. LPA reviewed 7 children’s files and found 1 out of 7 files incomplete, file was missing the LIC 701.

Based on record reviews, there is a preponderance of evidence to prove the above allegations did occur Therefore, the allegation of staff and children’s record keeping is to be SUBSTANTIAED. Please see LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 30-CC-20240821131500
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SANTA MONICA MONTESSORI SCHOOL
FACILITY NUMBER: 197410539
VISIT DATE: 09/05/2024
NARRATIVE
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Page 2
Upon on receipt of this report, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted, and report was reviewed with Pamela Crisman. Copy of this report and appeal rights were discussed and left with director whose signature on this form confirm receipt of these
documents.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 30-CC-20240821131500
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA MONICA MONTESSORI SCHOOL
FACILITY NUMBER: 197410539
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
101217(a)(11)
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101217 Personnel Records (a) The licensee shall ensure that personnel records are maintained ...
(11) A health screening as specified in Section 101216(g).
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Facility agrees to have staff submit a completed LIC 503 and copy will be submitted to LPA via email.
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This requirement is not met as evidenced by: 2 out of 10 staff files did not have a completed Health Screening LIC 503.
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Type B
09/26/2024
Section Cited
HSC
1596.7995(c)
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(c) The day care center shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the day care center.
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Facility agrees to collect proof of immunization records: MMR and Dtap for the 6 incomplete staff files. Proof will be emailed to LPA.
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This requierment is not met as evidence by: 6 out of 10 staff files did not have proof of immunization record: MMR and dtap
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 30-CC-20240821131500
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA MONICA MONTESSORI SCHOOL
FACILITY NUMBER: 197410539
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
101217(a)(6)
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101217 Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (6) Documentation of the educational background, training and/or experience specified in this chapter.
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Facility agrees to have staff renew the Mandated Reporter Training for Child Care Providers and submit documentation to LPA via email.
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This requirement is not met as evidenced by: 2 out of 10 staff files did not have a valid Mandated Reporter Training completed on file.
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https://mandatedreporterca.com/training/child-care-providers
Type B
09/26/2024
Section Cited
CCR
101220(a)(1)
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101220 Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child... (1) Such assessment shall be performed by, or under the supervision of, a licensed physician, and shall not be more than one year old when obtained.
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Facility agrees to have the LIC 701 completed and proof will be sent to LPA via email.
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This requierment is not met as evidence by: 1 out of 7 children's file were incomplete, missing a completed Physician's Report.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4